MS Flashcards
what is the pathophysiology behind MS?
inflammatory demyelination condition affecting CNS
plaques disseminated in time and place
what are the common sites for demyelination in MS?
optic nerve
spinal cord
cerebellum
peri-ventricular white matter
what are the main pathological findings in MS?
varying degrees of inflammation
peri-vascular inflammation and oedema
neuronal loss with reactive astrocyte gliosis
what is a very common symptom with MS?
lethargy
what are motor symptoms associated with MS?
pyramidal weakness
gait abnormalities
what are sensory symptoms associated with MS?
numbness/tingling
pain
what are cerebellar symptoms associated with MS?
incoordination (ataxia)
tremor
dysarthria
what are symptoms of the eyes in MS?
sudden loss of vision double vision (nystagmus)
what a are bowel/bladder symptoms in MS?
alteration to normal habits
what kind of motor neurone signs are seen in MS?
UMN:
spasticity
brisk reflexes
positive babinski
what signs are seen in the eyes?
nystagmus
RAPD - optic neuritis
what is Lhermittes phenomenon?
electric shock down spine and arms when head is bent forward
what is Uhtoffs phenomenon?
worsening of symptoms with heat and exercise
what is Hoffmans relfex?
flexion of thumb on tapping nail or flicking distal phalanx of middle finger
what is the most common subtype of MS?
relapsing and remitting
what is relapsing and remitting MS?
unpredictable relapses of varying severity with complete recovery seen
what will most patients with relapsing and remitting go on to develop?
secondary progressive MS
what is secondary progressive MS?
relapses with incomplete recovery and acute relapses superimposed
steady neurological decline and increased disability
what is primary progressive MS?
steady neurological decline with no periods of remission following onset of symptoms
what is progressive relapsing MS?
steady neurological decline from onset of symptoms with super imposed relapses
what is the diagnostic criteria for MS?
2 episodes of symptoms suggestive of MS that last at least 1 hour and are at least 30 days apart
(shows dissemination in time and place)
what investigations are used to diagnose MS?
auto antibodies
MRI
lumbar puncture
evoked potentials
what is shown on MRI in MS?
identified optic neuritis
plaques of demyelination
what is seen in lumbar puncture in MS?
oligoclonal bands of IgG
what are evoked potentials? what is seen in MS?
time between visual stimulation and response in brain
delayed in MS
what is the aim of management in MS?
reduce relapses
no cure
what drugs are used in MS to treat spasticity?
1st line baclofen/gabapetin
physiotherapy
what drugs are used to treat sensory symptoms?
amitriptyline
gabapentin
what is used to manage bladder dysfunction?
bladder training
anti cholinergic - oxybutinin
what is used in relapse management?
IV steroids - methylprednisolone
plasma exchange - plasmapheresis (to remove autoantibodies)
what disease modifying drugs are first line in MS?
B interferon
capaxone (glitramer acetate)
tedfidera
what are the side effects of b interferon?
flu like symptoms
depression
what are the side effects of capaxone?
flu like symptoms
what are the side effects of tecfidera?
progressive leukonecphalopathy
in JC virus positive patients
